A nurse is caring for a mother who delivered vaginally 2 hours ago.Select the 4 findings the nurse should report to the provider.

Fundus midline and firm at the umbilicus.

Moderate lochia rubra with no clots.

Constant trickle of blood at the vagina.

Hemoglobin level.

Heart rate.

Answer and Explanation

Correct Answer : C,D,E

Choice A rationale

A fundus midline and firm at the umbilicus is a normal postpartum finding and does not require reporting. It indicates that the uterus is contracting as expected to prevent postpartum hemorrhage.

Choice B rationale

Moderate lochia rubra without clots is expected in the immediate postpartum period and does not need to be reported. It is part of normal postpartum bleeding as the uterus sheds its lining.

Choice C rationale

A constant trickle of blood at the vagina postpartum could indicate a laceration or retained placental fragments and should be reported to the provider for further evaluation and management.

Choice D rationale

Hemoglobin levels can provide important information about the mother's blood loss during delivery. A low hemoglobin level could indicate significant blood loss and necessitates reporting.

Choice E rationale

An abnormal heart rate in a postpartum mother could be indicative of complications such as hemorrhage or infection and should be reported to the provider for further assessment.

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Correct Answer is D

Explanation

Choice A rationale

Clear fluid oozing from a pilonidal sinus is unrelated to congenital hip dysplasia and more associated with other conditions like pilonidal cysts.

Choice B rationale

A positive hip click can indicate hip instability but is not definitive for congenital hip dysplasia.

Choice C rationale

Erythema toxicum is a benign, self-limiting skin condition and does not relate to hip dysplasia.

Choice D rationale

Limited abduction of the hip is a key sign of congenital hip dysplasia, indicating restricted movement due to abnormal hip joint development. .

A. Dry the infant off and cover the head. B. Stimulate the infant to cry. C. Clear the respiratory tract. D. Assess the umbilical cord.

Correct Answer is C

Explanation

Choice A rationale

Drying and covering the infant helps prevent heat loss and maintain body temperature, which is essential for newborns immediately after birth.

Choice B rationale

Stimulating the infant to cry helps clear the airways but is usually done after ensuring the respiratory tract is clear.

Choice C rationale

Clearing the respiratory tract is the priority immediately after birth to ensure the newborn can breathe properly and reduce the risk of aspiration.

Choice D rationale

Assessing the umbilical cord is important but not the first priority. Ensuring the airway is clear takes precedence to establish effective breathing. .

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A nurse is caring for a mother who delivered vaginally 2 hours ago.Select the 4 findings the nurse should report to the provider.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assisting the health care provider (HCP) in examining an infant with suspected congenital hip dysplasia.What sign should the nurse expect to find during the assessment?

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

The nurse is assessing a 40-week small for gestational age (SG

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